TY - JOUR
T1 - Prognostic value of malnutrition assessed by Controlling Nutritional Status score for long-term mortality in patients with acute heart failure
AU - on behalf of the NaDEF investigators
AU - Iwakami, Naotsugu
AU - Nagai, Toshiyuki
AU - Furukawa, Toshiaki A.
AU - Sugano, Yasuo
AU - Honda, Satoshi
AU - Okada, Atsushi
AU - Asaumi, Yasuhide
AU - Aiba, Takeshi
AU - Noguchi, Teruo
AU - Kusano, Kengo
AU - Ogawa, Hisao
AU - Yasuda, Satoshi
AU - Anzai, Toshihisa
N1 - Funding Information:
We are grateful for the contributions of all the investigators, clinical research coordinators, and data managers involved in the NaDEF study. This work was supported by a Grant from the Japan Cardiovascular Research Foundation (T.A., 24-4-2), and a Grant-in-Aid for Young Scientists from the Japan Society for the Promotion of Science (T.N., 15K19402).
Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background The prognostic value of nutritional status is poorly understood and evidence-based nutritional assessment indices are required in acute heart failure (AHF). We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT) score (range 0–12, higher = worse, consisting of serum albumin, cholesterol and lymphocytes) in AHF patients. Methods The CONUT score was measured on admission in 635 consecutive AHF patients. The primary outcome was all-cause death. Results Median CONUT score was 3 (interquartile range 2 to 5). During the median follow-up of 324 days, CONUT score was independently associated with death (HR 1.26, 95% CI 1.11–1.42, P < 0.001) after adjustment for confounders in a multivariate Cox model. The CONUT score demonstrated the best C-statistic for predicting death (0.71) among other common nutritional markers in HF. Furthermore, addition of the CONUT score to an established risk prediction model from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure study significantly increased the C-statistic from 0.75 to 0.77 (P = 0.02). The net reclassification improvement afforded by CONUT score was 21% for all-cause death, 27% for survival and 49% overall (P < 0.001). Conclusion Malnutrition assessed by the CONUT score on admission was an independent determinant of long-term death in AHF, and its prognostic value outweighed that of other nutritional indices. Moreover, addition of the score to the existing risk prediction model significantly increased the predictive ability for death, indicating beneficial clinical application of the CONUT score in AHF patients.
AB - Background The prognostic value of nutritional status is poorly understood and evidence-based nutritional assessment indices are required in acute heart failure (AHF). We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT) score (range 0–12, higher = worse, consisting of serum albumin, cholesterol and lymphocytes) in AHF patients. Methods The CONUT score was measured on admission in 635 consecutive AHF patients. The primary outcome was all-cause death. Results Median CONUT score was 3 (interquartile range 2 to 5). During the median follow-up of 324 days, CONUT score was independently associated with death (HR 1.26, 95% CI 1.11–1.42, P < 0.001) after adjustment for confounders in a multivariate Cox model. The CONUT score demonstrated the best C-statistic for predicting death (0.71) among other common nutritional markers in HF. Furthermore, addition of the CONUT score to an established risk prediction model from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure study significantly increased the C-statistic from 0.75 to 0.77 (P = 0.02). The net reclassification improvement afforded by CONUT score was 21% for all-cause death, 27% for survival and 49% overall (P < 0.001). Conclusion Malnutrition assessed by the CONUT score on admission was an independent determinant of long-term death in AHF, and its prognostic value outweighed that of other nutritional indices. Moreover, addition of the score to the existing risk prediction model significantly increased the predictive ability for death, indicating beneficial clinical application of the CONUT score in AHF patients.
KW - Acute heart failure
KW - Cachexia
KW - Controlling Nutritional Status score
KW - Malnutrition
KW - Prognosis
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U2 - 10.1016/j.ijcard.2016.12.064
DO - 10.1016/j.ijcard.2016.12.064
M3 - Article
C2 - 28041709
AN - SCOPUS:85009493276
VL - 230
SP - 529
EP - 536
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -